比较两种手术方式治疗重度精索静脉曲张对患者生精功能的影响*

目的应用显微镜下高选择精索静脉高位结扎术与传统的Palomo术,治疗重度精索静脉曲张患者,就两种术式对改善患者精液参数、性激素水平的疗效进行比较.方法选择原发性重度(Ⅲ度)精索静脉曲张患者50例,根据手术方式随机分成两组:A组是显微镜下经腹股沟途径保留精索内动脉、淋巴管的高选择性精索静脉结扎术组,25例;B组为传统Palomo术,25例.比较两组术前和术后3个月、6个月精液参数(精子密度、精子总数和精子活力)、性激素水平[血清卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)]、抑制素B(INHB)的变化.结果经过3个月、6个月随访,A、B组术后精子密度、精子总数、精子活力和血清T、INHB水平均提高,手术前后差异具有统计学意义(P<0.05);A组术后FSH、LH降低,手术前后差异具有统计学意义(P<0.05),术后3个月B组FSH、LH有降低,但手术前后差异无统计学意义(P>0.05);术后6个月FSH、LH降低,手术前后差异具有统计学意义(P<0.05).术后6个月A组精子活力、INHB提高程度大于B组,差异具有统计学意义(P<0.05);术后6个月A组FSH、LH降低程度大于B组,差异具有统计学意义(P<0.05);术后A组精子密度、精子总数、血清T提高程度与B组比较差异不明显,无统计学意义(P>0.05).结论两种术式治疗精索静脉曲张,均能改善患者的精液质量,而显微外科手术对患者精子活力和INHB提高程度以及FSH、LH的降低程度大于传统的Palomo手术.     

实验性精索静脉曲张大鼠生精状态评价

目的 通过对大鼠实验性精索静脉曲张(varicocele,VC)模型睾丸生精小管生精上皮结构、性激素水平的分析,探讨精索静脉曲张致不育的机制.方法 40只雄性青春期Wistar大鼠随机分为VC8周组(n=12)、VC12周组(13=12)和相应对照组(分别n=8);左肾静脉部分结扎建立实验性大鼠VC模型.术后8周或12周,分别测量各组大鼠:(1)左侧精索静脉直径、睾丸温度及体质量、睾丸生精小管生精上皮;(2)外周血中促卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)的水平.结果 VC8周和VC12周组大鼠左侧精索静脉明显扩张,与对照相比血管直径差异有统计学意义(P<0.01);VC8和VC12周组大鼠左侧睾丸体质量均低于自体右侧睾丸和对照组睾丸,差异有统计学意义(P<0.05);光镜下,VC组大鼠双侧睾丸生精小管生精上皮精子发生阻滞、细胞脱落和细胞层数减少等,VC12周组损伤程度较VC8周组明显加重,左侧较右侧显著;与对照组相比,VC组大鼠外周血FSH、LH升高,T降低,差异均有统计学意义(P<0.01).结论 本研究提示:VC对大鼠双侧睾丸生精小管生精上皮产生明显的损害作用,并导致大鼠血中T水平降低和FSH、LH水平升高.     

精索静脉曲张不育患者手术前后血清抑制素水平变化的研究

目的 研究精素静脉曲张手术治疗对血清抑制素B(inhibinB,简称InhB)水平的影响,从而了解精素静脉曲张不育患者手术后生育能力的变化.方法 选取30例患有精素静脉曲张的男性不育患者,对所有患者行腹膜后精索内静脉高位结扎术,分别于手术前和手术后3个月测定血清InhB、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)和精子密度,分析它们的变化.结果 精索静脉曲张不育患者手术后较手术前血清InhB水平显著升高;血清FSH、LH、T手术前后均无显著性变化:精子密度手术后较手术前显著提高.结论 精素静脉曲张手术治疗能使血清InhB水平升高,从而说明了手术对精子发生及支持细胞功能的改善.     

Ⅲ度精索静脉曲张患者显微结扎术后生精功能的变化

目的：研究Ⅲ度精索静脉曲张显微结扎术后生精功能的变化,以探讨手术的价值.方法：选择Ⅲ度精索静脉曲张并男性不育患者118例,观察其显微结扎术前后睾丸体积、精子密度、活率、形态、血清卵泡刺激素（FSH）、睾酮（T）及抑制素B浓度的变化.结果：患者手术6个月后的左侧睾丸体积（P〈0.05）、精子密度（P〈0.01）及活率（P〈0.05）均明显提高,血清FSH水平明显降低（P〈0.05）,T（P〈0.01）及抑制素B（P〈0.05）水平明显提高.而睾丸体积及精子形态无显著变化.结论：显微结扎术能改善Ⅲ度精索静脉曲张患者的生精功能.     

隐睾患儿血清FSH、LH、T水平及其临床意义

目的研究隐睾患儿血中促卵泡激素(FSH)、促黄体激素(LID和睾酮(T)激素水平变化,探讨其临床意义及在隐睾症发病中的作用。方法应用化学发光免疫技术检测42例隐睾症和23例斜疝(对照组)患儿血清FSH、LH、T水平。结果单侧隐睾症组和斜疝组之间血清FSH、LH和T水平无显著性差异(P＞0．05)；(2)双侧隐睾组血清FSH水平高于斜疝组,差别有统计学意义(P＜0．05)；单侧隐睾症组血清FSH高于斜疝组,低于双侧隐睾症组,差别无统计学意义(P＞0．05)。结论(1)血清中性激素LH和T水平的变化在隐睾发生中并不起主要作用；(2)血清FSH水平的升高可能反映睾丸功能损害严重程度。     

特发性无精子症与精索静脉曲张无精子症的生殖内分泌及睾丸病理学研究

对特发性无精子症50例、精索静脉曲张无精子症16例及对照57例分别从血FSH、LH和T,睾丸体积,曲细精管直径、管壁厚度、管内上皮及间质病变情况进行了比较。二类无精子症的FSH、LH及T水平无显著差异,但特发性的FSH、精索静脉曲张的LH有较对方升高更多的趋势。二类无精子症的睾丸体积、曲细精管直径及管壁厚度无明显差异,但精索静脉曲张无精子症曲细精管内细胞脱落严重并伴有间质水肿及小血管病变,而特发性无精子症则曲细精管内生精阻滞明显。提示间质病变及有可能继发于之的曲细精管内细胞脱落是精索静脉曲线无精子症有别于特发性无精子症的重要特征。     

生精汤治疗肾虚血瘀型弱精子症临床疗效观察

目的观察与探讨生精汤治疗肾虚血瘀型弱精子症疗效。方法将111例弱精子症不育患者随机分为两组,治疗组54例采用生精汤治疗,对照组57例口服中成药五子衍宗丸治疗。治疗前后对患者进行综合疗效评价,观察有无妊娠、精液质量检查和血清性激素(T、FSH、LH)。结果治疗组治疗前后比较,FSH、LH、PRL、A级精子百分率、B级精子百分率和存活率差异均有统计学意义(P0.01),T和精子密度差异无统计学意义(P0.05)。对照组治疗前后比较,FSH、LH、B级精子百分率和存活率差异有统计学意义(P0.01),T、PRL、A级精子百分率和精子密度差异无统计学意义(P0.05)。治疗后的治疗组患者T、FSH、LH和PRL水平与治疗后的对照组比较差异均无统计学意义(P0.05),A级精子百分率、B级精子百分率和密度与治疗后的对照组比较差异也无统计学意义(P0.05),存活率两组比较差异有统计学意义(P0.01)。结论生精汤对治疗肾虚血瘀型弱精子症具有一定疗效,明显改善了精子存活率、A级和B级精子百分率。     

腮腺炎致无精症患者睾丸切开取精结果与性激素水平和睾丸大小关系的研究

目的:探讨腮腺炎致无精症患者睾丸切开取精(TESA)与性激素、睾丸大小的关系。方法:52例腮腺炎致无精症患者经TESA,显微镜下观察能否找到活动的精子,电化学方法方法测定性激素(FSH、LH、T、PRL、E2)的水平,超声测量并计算睾丸体积。结果:52例患者TESA找到活精子38例(73.1%),血清FSH和LH水平,无精子组平均数明显高于有精子组,两间差异有统计学意义(P<0.05),血清T、E2、PRL组间差异无统计学意义。睾丸体积无精子组平均数小于有精子组,但组间差异无统计学意义(P>0.05)。以FSH值为标准,38例可找到活动精子患者中,正常范围之内的有23例(44.2%),高出正常值2倍范围内的有11例(21.2%),2倍范围之外的有4例(7.7%)。以睾丸体积为标准,38例可找到活动精子患者中,睾丸体积≥6ml有35例(67.3%),睾丸体积<6ml有3例(5.8%)。结论:睾丸体积和FSH水平可以作为腮腺炎致无精症患者预判取精成功概率的指标,所有患者都应该TESA,为单精子卵胞浆内注射创造机会。     

不育男性血清和精浆抑制素B水平与生精功能的关系

目的探讨血清和精浆抑制素B(INH-B)与睾丸生精功能的关系。方法回顾性分析2015年1~6月来深圳中山泌尿外科医院生殖医学中心就诊的141例男性不育症患者资料。根据精液参数分为5组:精子浓度正常组(A组,43例)、轻中度少精子症组(B组,40例)、重度少精子症组(C组,27例)、梗阻性无精子症组(OA组,9例)和非梗阻性无精子症组(NOA组,22例);NOA组中有17例患者接受睾丸细针精子抽吸术(TESA)取精,根据TESA结果分为成功组(13例)和失败组(4例)。比较各组的精液参数(精子总数、浓度及活动力),测定其血清和精浆INH-B水平及血清FSH、LH、T、E_2、泌乳素(PRL)、孕酮(P)的水平,分析血清性激素、INH-B与精液质量之间的关系。结果 A、B组的睾丸总体积显著高于OA和NOA组(P0.05)。C组和NOA组的血清INH-B显著低于A组和OA组,A组的精浆INH-B浓度显著高于C组、OA组和NOA组(P均0.05)。不同生精功能男性的血清INH-B与血清FSH、LH及PRL呈负相关,与血清T和精浆INH-B呈正相关(P均0.05);精浆INH-B与血清FSH和LH呈负相关(P0.05)。A、B、C组中血清和精浆INH-B与总精子数呈低度正相关(P0.01)。NOA组中血清INH-B与睾丸总体积呈高度正相关,与血清FSH和LH呈负相关(P均0.01);精浆INH-B与血清FSH呈极弱负相关(P0.05)。TESA取精成功组的睾丸总体积和血清INH-B显著高于TESA失败组,血清FSH和LH则显著低于TESA失败组(P均0.01)。结论血清和精浆INH-B与血清性激素、总精子数具有一定相关性,可作为评估男性生精功能的参考。无精子症中尤其是NOA患者,血清INH-B可以评估睾丸生精状态、鉴别诊断无精子症、预测取精结局。     

双侧和左侧静脉结扎术治疗左侧临床型并右侧亚临床型精索静脉曲张不育患者疗效的比较

目的 探讨左侧临床型合并右侧亚临床型精索静脉曲张(Varicocele,VC)不育患者双侧精索内静脉结扎术(Bilateral Varicocelectomy,BV)是否优于单纯左侧精索内静脉结扎术(Left Varicocelectomy,LV).方法 将接受BV (n=51)和LV (n=53)的两组患者手术前后参数进行方差分析和x2检验比较.结果 两组患者术前参数有可比性(P＞0.05);术后两组患者精子参数显著改善(P＜0.05),但血清睾酮浓度和睾丸体积无显著性改变(P＞ 0.05),术后两组间参数比较差异无统计学意义(P＞0.05).结论 BV和LV两组疗效相当.     

Seminal plasma hormone profile in infertile men with and without varicocele

Seminal plasma FSH, LH, prolactin, testosterone, and oestradiol were estimated in 41 infertile men with varicocele and 45 infertile men without varicocele who failed to impregnate their wives after 2 years of marriage and 30 fertile men. There was significant elevation of FSH in the seminal plasma of the infertile men with varicocele compared with the seminal plasma of the other infertile and fertile men. Seminal LH and prolactin values were similar in both infertile groups but significantly higher than in the fertile men. Testosterone and oestradiol levels in the seminal plasma of infertile men with varicocele were lower than in the fertile and the other infertile males. Finding that both steroids were decreased in infertile men with varicocele could explain disturbed function of spermatozoa in men with varicocele. Further analysis will elucidate the importance of these hormone findings in the seminal plasma of infertile men with varicocele.     

Pituitary Gonadal Function in Infertile Men with Varicocele

Infertile men with varicocele or idiopathic infertility were compared with a control group. Spermocytograms were taken and the following radioimmunological plasma analyses carried out: testosterone, FSH and LH before and after 50 micrograms LRH, Prolactin (PRL) before and after 200 micrograms TRH; in addition, 8 patients with varicoceles and 3 controls received LRH intravenously (0.4 microgram/min.) for 4 hours. The binding of [125I] human chorionic gonadotrophin (hCG) to testicular tissue obtained by biopsy from 10 infertile men was also investigated. Of the parameters studied, no differences were found between the unilateral or bilateral varicoceles. In the two groups of infertile men, sperm motility and percentage normal forms were similar and significantly lower than in controls. As compared to the controls, in the groups of infertile men, basal LH and testosterone levels were no different but basal FSH levels was increased, basal PRL was higher (p less than 0.05) in the varicocele group. Responses of the LH, FSH and PRL to LRH and TRH stimulations were generally higher in infertile men than in controls. As compared to the idiopathic infertile men, testosterone levels and responses of plasma FSH to LRH injection were lower in varicocele group. Moreover, in infertile men with varicocele, age was correlated negatively with sperm motility and testosterone level and it was correlated positively with LH response to LRH injection. For each patient, testicular tissue was able to specifically bind [125I]hCG, but in some cases of varicoceles, hCG binding capacity was different in the two testes and seemed higher than that observed in men with obstructive azoospermia. These results suggest: 1) dysfunction in both spermatogenesis and Leydig cells with a compensatory hyperfunction of the pituitary gland in infertile men with varicocele; 2) worsening in Leydig cells and tubular lesions with longer duration of varicocele; and 3) absence of any gross abnormality in hCG binding to its specific receptors in the testis of men with varicocele. These data suggest varicoceles may play a causal role in infertility.     

精索静脉曲张不育患者手术前后血浆性激素变化

将６４例单纯精索静脉曲张源性不育患者随机分为手术组３３例与非手术组３１例，分别于术前及术后６个月测血浆卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）、睾酮（Ｔ），同时测４６名正常生育力男性性激素作为正常值对照，对两组不育患者还进行了睾丸体积测定和精液分析。手术组采用经髂窝腹膜外单纯精索内静脉高位结扎术。结果：６４例精索静脉曲张源性不育患者精子密度、精子存活率、睾丸体积低于正常组，ＦＳＨ、ＬＨ、Ｔ均在正常值范围，与正常组对照无明显差异。两组手术前后对照分析，手术组与非手术组手术前后血浆性激素虽无统计学差异，但手术组患者术后精液质量、睾丸体积明显改善，随访一年手术组妊娠率（２７％）显著高于非手术组（１３％）。术前ＦＳＨ较高的患者术后精液质量、睾丸体积无明显改善，而术前ＦＳＨ正常者有显著差异。认为，精索静脉曲张不育患者通过手术治疗确能提高其生育能力，而术前根据血浆ＦＳＨ、ＬＨ、Ｔ测定结合睾丸检查、精液分析可以初步估计睾丸受损程度，对手术预后的判断有一定参考价值。     

Differences in the clinical characteristics between young and elderly men with varicocoele

Information concerning the clinical characteristics in elderly men with varicocoele is relatively limited. This study was assessed to evaluate the differences in clinical characteristics between young and elderly patients with varicocoele by retrospective chart review. Between June 2003 and February 2011, 169 young (18-30?years) men and 156 elderly (45-55?years) men with varicocoele, and 30 age-matched men without varicocoele were recruited for this study. All the patients were divided into six groups. Thirty-one infertile patients were assigned to Group 1, 138 fertile patients to Group 2, 35 infertile patients to Group 3 and 121 fertile patients to Group 4. Group 5 (15 young) and 6 (15 elderly) were control groups. The parameters for comparison included body mass index (BMI), semen quality (sperm motility, morphology and density) and pH value, serum concentration of follicle-stimulating hormone (FSH), luteinizing hormones (LH), testosterone, testicular volume, grade of varicocoele and peak retrograde flow (PRF) and maximal vein diameter (MVD) by colour Doppler ultrasound (CDS). Elderly men with varicocoele had a higher incidence of bilateral varicocoele (25.5% vs. 14.8%), but a lower incidence of unilateral right varicocoele (2.6% vs. 7.7%) than young patients with varicocoele. In addition, patients with varicocoele had lower BMI than those without, and infertile young patients with varicocoele had the lowest levels of BMI. Furthermore, infertile patients (Groups 1 and 3) with varicocoele had significantly lower testicular volume and semen pH, lower levels of testosterone, higher levels of FSH and LH and higher PRF than fertile men with varicocoele (Groups 2 and 4). In conclusion, infertile elderly patients with varicocoele had significantly lower levels of testosterone and higher levels of FSH and LH than infertile young men with varicocoele. In addition, infertile elderly patients with bilateral varicocoele (Group 3, n?=?8) had the lowest levels of testosterone.     

The role of reactive oxygen species in testicular dysfunction associated with varicocele

OBJECTIVE: To determine the level of malondialdehyde (MDA), an indirect indicator of lipid peroxidation-induced injury by reactive oxygen species, in testicular biopsy specimens from infertile patients with and without varicocele. PATIENTS AND METHODS: Levels of MDA were measured in the testicular biopsy specimens from 25 infertile men (15 with varicocele, mean age 30.0 years, SD 5.7, range 23-45, and 10 without, mean age 28.7 years, SD 4.2, range 21-34). All patients were evaluated by a detailed history, physical examination, semen analysis (at least twice), serum follicle-stimulating hormone and free testosterone levels, testicular biopsy and contact imprint. Scrotal colour Doppler ultrasonography was used to confirm suspected varicocele. The level of MDA in testicular biopsy specimens was measured using the thiobarbituric acid test and the results expressed per unit tissue weight. RESULTS: As a causal factor for infertility, varicocele was identified in 15 men (60%), testicular failure in four (16%), idiopathic infertility in four (16%) and obstruction in two (8%). Of the 15 patients with varicocele, eight had bilateral varicocele and it was subclinical in three; the varicocele was grade I in four, grade II in six and grade III in two. The mean (SD) MDA level in the men with a subclinical varicocele was 15.7 (3.1) pmol/mg tissue, while in those with grade I-III varicocele it was 32.9 (12.25), 37.1 (12.25) and 86.9 (2.89) pmol/mg tissue, respectively. The levels in patients with grade III varicocele were significantly greater than in the other groups (P < 0.05). The mean MDA level in patients with or without varicocele was 38.3 (22.92) and 33.5 (18.93) pmol/mg tissue, respectively (P > 0.05). CONCLUSION: These results suggest that increasing levels of MDA are associated with higher grades of varicocele and support a possible rationale for controlled trials in infertile men with varicocele.     

Programmed cell death in varicocele-bearing testes

Accelerated apoptosis is a significant factor in the pathophysiology of male infertility disorders associated with abnormal spermatogenesis. This study aimed to investigate apoptosis in varicocele-bearing testes. Sixty four men with varicocele (18 fertile and 46 infertile) were studied compared with eight men with obstructive azoospermic as controls. Apoptosis was assessed in testicular biopsy specimens using terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling (TUNEL) method as well as electron microscopy. The results demonstrated that the occurrence of apoptotic changes comprised all types of germ cells but not affecting Sertoli cells. Mean tubular apoptotic indices of fertile or infertile men with varicocele were significantly higher than controls (mean ± SD 4.55 ± 1.03%, 6.29 ± 1.82% versus 2.71 ± 0.45%, P  < 0.05). Mean Leydig cells apoptotic indices of infertile men with varicocele were significantly higher than those of fertile men without varicocele as well as controls (1.18 ± 0.38%, 0.68 ± 0.15%, 0.31 ± 0.21%, P  < 0.05). Apoptotic indices were nonsignificantly correlated with Johnsen score, testicular volume or varicocele grade. It is concluded that testicular apoptosis is increased in varicocele-associated men either fertile or infertile who may be implicated in associated spermatogenic dysfunction.     

Spermatogenesis and spectral echo-colour Doppler traces from the main testicular artery

OBJECTIVE: To assess whether the peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistive index (RI) of testicular arteries may be useful in distinguishing the various causes of dyspermia when compared with follicle-stimulating hormone (FSH) and testicular volume. PATIENTS, SUBJECTS AND METHODS: The study included nine men with obstructive and 20 with unobstruc-tive azoospermia, 17 with oligoasthenospermia and clinical varicoceles, with male accessory glans inflammation (MAGI), 38 with undetermined oligoasthenospermia, 19 with MAGI, 11 with clinical varicoceles, 32 subjects with normal sperm analysis and recent paternity (fertile controls), and 15 with normal sperm analysis and a varicocele with recent paternity (fertile + varicoceles). Testicular volume, FSH, PSV, EDV and RI were compared among the dyspermic and/or control groups using analysis of variance. RESULTS: The PSV and RI were useful for identifying the different groups of patients, while EDV, FSH and testicular volume were not. Men with varicoceles, varicoceles + MAGI or fertile with varicoceles had the highest PSV and RI; fertile controls, those with obstructive azoospermia and MAGI had similar PSVs and RIs, those with unexplained oligoasthenospermia had a significantly lower PSV and RI, and men with unobstructive azoospermia had the lowest PSV and RI. CONCLUSIONS: The RI and PSV are reliable indicators for routine clinical use to identify infertile/dyspermic men, while EDV, FSH and testicular volume are not. The RI and especially PSV clearly differentiated obstructive from unobstructive azoospermia.     

Preservation of testicular arteries during subinguinal microsurgical varicocelectomy: clinical considerations

Microsurgical varicocelectomy with intentional preservation of the testicular artery(ies) is regarded as the gold standard approach to varicocele repair. We sought to determine whether the number of testicular arteries preserved at the time of micro-surgical varicocelectomy predicts improvement in postoperative semen parameters. We analyzed the records of 334 infertile men who underwent varicocelectomy performed by a single surgeon using a subinguinal microsurgical technique between July 1996 and January 2003. We examined the association between the number of testicular arteries preserved at the time of varicocelectomy and serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), varicocele grade, testicular volume, and postoperative improvement in semen parameters. Unilateral, left-sided varicocelectomy was performed in 194 men, while bilateral varicocelectomy was performed in 140 men. Mean (+/-SE) sperm concentration (20.1 +/- 1.5 x 10(6)/mL to 26.7 +/- 1.9 x 10(6)/mL, P =.001), percent motility (24.7 +/- 1.0% to 30.9 +/- 1.2%, P =.001), and percent normal morphology (35.8 +/- 1.4% to 37.7 +/- 1.5%, P =.046) improved significantly following varicocelectomy. The mean number of preserved testicular arteries was 1.5 on the left (range, 1-4) and 1.5 on the right (range, 1-4). The number of testicular arteries preserved at the time of varicocelectomy did not correlate significantly with preoperative assessment of serum FSH, LH, varicocele grade, and testicular volume or with postoperative improvement in semen parameters. Our data indicate that preoperative parameters are not predictive of the number of testicular arteries identified at the time of microsurgery. These data also suggest that the number of arteries identified and preserved with meticulous spermatic cord dissection does not correlate with improvement in semen parameters.     

Plasma gonadotrophic hormones, testicular biopsy and seminal analysis in the men of infertile marriages.

The first step in the investigation of infertile men is to obtain 2 seminal analyses 3 days after the previous ejaculation. Clinical assessment of testicular size is an unreliable means of assessing spermatogenesis and is best done by performing bilateral testicular biopsies. Azoospermic men with grossly elevated FSH levels should be advised to consider AID or adoption. Those with normal or mildly elevated FSH levels should undergo testicular exploration in an attempt to correct an obstructive lesion. Azoospermic men with subnormal FSH levels may have an isolated hormone defect which will respond to treatment with Pergonal. Different treatment programmes for oligozoospermic men depending on the results of the FSH and LH assays may lead to a more rational approach to therapy. Infertility associated with varicocele may possibly be associated with a local disturbance of "inhibin" and FSH concentrations.     

Assessment of seminal granulysin in infertile men with varicocele

Varicocele has a common association with male infertility, but its exact role is still debated. Apoptosis has been suggested as one of the mechanisms of varicocele‐associated infertility. Granulysin is a molecule that plays a role in apoptosis with no previous study about its role in male infertility. This case‐controlled study aimed to assess seminal plasma granulysin level in infertile patients with varicocele. This study involved 90 men that were allocated into fertile normozoospermic men (n = 20), infertile men without varicocele (n = 30) and infertile men with varicocele (n = 40). These men were subjected to history taking, clinical examination, semen analysis and estimation of seminal granulysin. In general, seminal granulysin level was significantly elevated in infertile men compared with fertile men. Infertile men with varicocele showed significantly higher seminal granulysin compared with infertile men without varicocele, in bilateral varicocele cases and in grade III varicocele. Seminal granulysin level was negatively correlated with sperm concentration, sperm motility, sperm normal forms percentage and testicular volumes. It is concluded that increased seminal granulysin has a negative impact on spermatogenesis in infertile men in general and in infertile men associated with varicocele in particular.